Wednesday, July 7, 2010

Food Stamps for Doctors: Mass Legislature Votes Today

Today, the Massachusetts legislature will consider a measure introduced by House speaker Robert DeLeo to repeal the historic drug company gift ban law enacted only two years ago. Why? Because wealthy restaurant owners are lobbying to return the state to the days when it was a haven for wining and dining doctors.

The interesting thing is that doctors themselves have resigned themselves to the law, and have largely embraced it. For example, Partners Healthcare, which includes both Mass General Hospital and Brigham and Women’s, forbids its staff from accepting any drug company meal, on site or off-site, and has banned its faculty from giving “educational” talks at restaurants (read their policy here).

It’s rather embarrassing that Massachusetts lawmakers have decided to ignore Harvard Medical School’s example, and are instead receiving their health policy instruction from restauranteurs. The most vocal of these nouveau medical ethics gurus has been Steve DiFillippo, owner of the Davio’s chain of Northern Italian Steakhouses, Avila’s, and a new line of Davio’s frozen foods. Below is a picture of Steve posing with Mayor Menino at the opening of one of his restaurants.Last April, DiFillippo appeared on WGBH's Greater Boston to present his own version of Medical Ethics 101: “Besides my parents," he said, "who do I trust the most? It’s my doctor. I trust my doctor to go to an educational dinner where it's doctor on doctor and learn about the drug. And recommend the right drug.”Emily Rooney: “You don’t think they are going to be unduly influenced?”

Steve DiFillippo: “We’re talking about doctors. You know, they go to doctor school for 12 years…to become a doctor. I think I can trust my doctor to make an educational decision.”

I appeared with DiFillippo on that program. What viewers did not see was that in the pre-show lounge, DiFillippo was working the crowd. Speaker Robert Deleo happened to also be in the lounge, where he was waiting to be interviewed about his effort to legalize casino gambling in Massachusetts. DiFillippo planted himself by his side and groused about how much income restaurants were losing from the ban on free meals for doctors. It was an eye-opener for me, seeing the political process in action. DeLeo and DiFillippo obviously knew one another from somewhere. They shook hands, they smiled, they chatted--it was the ancient machinery of wealth multiplying itself by rubbing up against power.

Evidently, DiFillippo’s knew what he was doing, because within three months, DeLeo had introduced legislation to repeal the gift ban. I assume that the Speaker has his heart in the right place in that he wants to stimulate the Massachusetts economy. Unfortunately, he is willing to trade ethics for money, both in his successful championing of casino gambling (a shady recreational pursuit which has ruined several of my patients’ lives) and now in his willingness to allow drug companies to resume bribery-as-usual of Massachusetts doctors.If you happen to be a doctor looking forward to a bright future of free meals, here is a portion of Davios’ steakhouse offerings. Lick your chops!

13 comments:

Anonymous
said...

I am speechless. DeLeo should be ousted. And DiFillippo should be publicly shamed. Although I'm sure as long as the money continues to pour in he probably wouldn't care. Perhaps someone needs to put a private investigator on him and dig up some serious dirt to expose.

The pharma industry is pretty much universally disliked/hated among those who provide and are the recipients of healthcare. DiFillippo's strategy may not be as successful as he hopes. Doctors' shifty behavior in taking drug company money and perks has been widely exposed in the media for several years now. Most of my doctors no longer associate with pharma because of that. The doctor gift law served to heighten the public's knowledge about what was going on. If DiFillippo thinks that drug pushers will be able to host dinners that will bring him as much money as he made before, I suspect he is sorely mistaken. After all, doctors have business reputations to maintain, too. Even if the dinners ARE "doctor on doctor", Mr. DiFillippo, Doctors are onto the shifty sales pitches of their colleagues who take money from drug companies.

And if drug pushers were hosting so many meals at restaurants as expensive as Davio's that the owner of Davio's is now complaining about the ban, then for goodness sake, we NEED the doc gift law.

I dunno, and I have different take on it. I happen to agree with restaurant owner Steve DiFillippo. I mean he is running a legitimate business. So what business is the government's to specify who can and can't frequent his establishment? DiFillippo is not the enemy.

Targeting restaurant owners is a transparent diversion from the root cause of the Big Pharma problem, which is the ethical morass that medicine has become. From the physicians that allow their professional decisions to be swayed by skewed marketing, to the greater medical Leviathan that enables the practice through tacit approval.

At the end of the day, it is the physicians who own the script pads, physicians who approve journal articles, physicians who select and promote medical faculty and physicians who produce and certify CME. This problem won't be fixed until doctors look at themselves and say, "We have met the enemy and he is us."

I've said it before, physicians already have a full complement of available means to police themselves. I.e., censure, reprimand, shunning, suspension from journal publication, suspension from CME presentation, suspension from professional societies.

Doctors could make the problem go away tomorrow if they collectively really wanted to. E.g., get up and walk out of the conference room en masse when Charley Nemeroff is introduced at the Georgia psychiatric convention.

I'd like to see that kind of discipline enforced by doctors themselves before they start going after the Steve DiFilippo’s of the planet who are merely instrumental props.

Dear Steve M - You said: "physicians already have a full complement of available means to police themselves. I.e., censure, reprimand, shunning, suspension from journal publication, suspension from CME presentation, suspension from professional societies."

Where's the data to support the claims of the restaurant/convention industries? Health Care For All comments on the issue: http://blog.hcfama.org/2010/06/23/data-shows-that-recession-not-pharma-gift-ban-is-issue-for-restaurants/

It is not well known from Civics class. The Free Speech Clause is a two sided coin. There is the well know freedom of expression. But, there is also the less well know freedom to hear speech. The Massachusetts law violates that aspect of Free Speech.

Government may not, but private entities such as hospitals may restrict speech by contractual agreement. Doctors are free to resign if they disagree.

As a doctor, I could not tolerate any employer who tried to restrict my speech activities. The restriction is inappropriate and extremely offensive to anyone older than 18 years old.

Do you know what I think? I think since I've been taking certain antipsychotics, mood-stabilizers and antidepressents for nearly 20 years now, I'm soon due drug-taking pensions from certain pharmaceutical companies. So, the money they are no longer spending on lavish dinners with doctors, they can send my way to start paying my drug-taking pension.

This guy Carlat is not a "drug whore," he's a MONEY WHORE. Plain and simple. I just listened to his NPR interview and his practice is revolting. He reveals he's a Short Order Cook for drug prescriptions masquerading as psychiatric care--with "100's of patients" in his practice. What kind of "care" do you think you get from some guy with "100's of patients in his practice" to whom he only dispenses drugs? He’s got to hear 2nd and 3rd hand of the dangerous behaviors of the patients to whom HE’S prescribing drugs. Do you think he even remotely remembers anything RELEVANT or personal about you? Then, he tells everyone he's the kind of guy who can be Bought and Sold by a drug company to be a hired shill. It is disgusting to think of ANY "doctor" stopping his day of medical practice to go do some shuck 'n jive to another doctor just to make a few coins from the Pimping-Drug Company. But, this doesn't bother this guy Carlat. BECAUSE THAT'S WHO HE IS. He stays for a year or more. Gee, some sense of standards there if it takes him a year to see that he's being used and degraded as a Money Whore. A Medical Doctor "ANSWERING" to Sales Representatives! Answering to Sales Managers! Sickening. He sold out before for Money. He’ll sell out again. He WANTS MONEY. THEN, he says he has his big break through of consciousness that "All this is wrong!" Wrong! Oh, what a genius. So what does he do? He writes books about his awakening and now goes around selling his books! Which, if you listen to what the guys says, he isn't bothered by all this not one wit. The drugs don't bother him at all...He just doesn't like the slimy strip tease he was doing to hack the drugs off on PATIENTS. He's going to "tell you about it now!" He's still a drug pusher instead of a medical doctor. The basis of his very life is pushing drugs. Oh, but "Buy my book and read all about it." This guy is EXACTLY the kind of doctor who gives all doctors a bad name.He ought to be forced to renounce his Hoppocratic Oath. This is everything that is destroying the art of medicine.

I think Lib may be thinking of the $500 med check, not the $50 med check. When he starts paying that amount out of his own pocket, then he has a right to speak as he does. He needs to find a friend in the outside world, not in the doctor's office.

There is no evidence showing a personal relationship with one's doctor makes any difference to outcome. People who have relationships for money are part of another profession. Indeed, success makes for a good relationship. And failure will not endear a doctor, no matter how solicitous, caring, or charming.

When ill, or in pain, I seek the fastest remedy to my torment, then it's, see you again when I need you. I want to pay well for technical knowledge that will solve my medical problem. I want to pay exactly zero dollars for friendship. Whether that is thrown in for free or not thrown in, I just don't care once my medical problem is solved.

If the relationship with the doctor is important, it implies, the patient is not sick enough to need a doctor. Sick people want relief, and don't care about anything else.

What are the policies that gift-giving pharmaceutical companies have about their employees’ receiving gifts?

Effective July 1, 2010, Vermont law bans giving gifts, with some exceptions, to healthcare providers. Before then, Vermont law required pharmaceutical manufacturers to disclose gifts to physicians and other health care professionals. The most recent data, for fiscal year 2009 (July 1, 2008 to June 30, 2009), show that the manufacturers spent about $2.6 million. Physicians and nurses received about $2.1 million of these gifts. Gifts worth less than $25 were exempt from disclosure. The top five spenders for marketing in Vermont during FY 2009 were Pfizer, Lilly, Forest, Merck, and GSK. These data, which do not reveal the actual amount spent by each company, are at http://tinyurl.com/27f5pmm.

Here are the policies of these top five spenders about their employees receiving gifts.

The Blue Book: Summary of Pfizer Policies on Business Conduct (http://tinyurl.com/25ufurl), p. 27Giving and Accepting Gifts, Entertainment, Loans, or Other FavorsThe Company prohibits you...from giving and receiving gifts, services, perks, entertainment, or other items of more than token or nominal monetary value to or from the Company’s suppliers, customers, or other third parties. Moreover, gifts of nominal value are permitted only if they are not given or received on a regular or frequent basis.~~~~~~~~~~

Lilly--The Red Book: Code of Business Conduct: English U.S.(www.lilly.com/pdf/red_book_eng_09.pdf), p. 40Employees must avoid situations in which personal interests, outside activities, or relationships conflict or appear to conflict with company interests.... Examples of potential conflicts include:...5. Gifts—Accepting gifts, entertainment, payment, or services from parties conducting business with or seeking to do business with Lilly~~~~~~~~~~~

Forest Laboratories Code of Business Conduct & Ethics (http://tinyurl.com/2auk2cm)4. Conflicts of InterestAll employees, officers and directors of the Company must be scrupulous in avoiding any conflict of interest.... Conflicts of interest may also include, situations where an employee...receives improper personal benefits as a result of his or her position in the Company.... Conflicts of interest are prohibited as a matter of Company policy, except under guidelines approved by the Board of Directors or committees of the Board.~~~~~~~~~~~

Merck & Co: Our Values and Standards: The Basis of Our SuccessEdition II Code of Conduct (www.merck.com/about/code_of_conduct.pdf), p. 10Receiving Gifts(While the receipt of gifts may be more common in the context of supplier relationships, these guidelines are included here for ease of reference and convenience.)As a common business courtesy, we may receive occasional gifts, provided that:• The gift is of nominal value (e.g., pens, notepads, calendars, etc.);...•The gift is neither intended nor likely to be perceived by others to improperly influence our business decisions. Occasionally, there may be times when refusing a gift would be impractical or embarrassing. In those rare instances where the gift is of substantial value, accept the gift on behalf of the Company, report it to your manager, and turn the gift over to your local/regional finance director, who will handle its disposition.~~~~~~~~~~~

GSK Code of Conduct (www.gsk.com/about/downloads/Policy-Code-Conduct.pdf), p. 34.3. Acceptance of Entertainment and GiftsGSK Staff may accept gifts or entertainment that are lawful and ethical, supports GSK’s business, (e.g., not just for staff well being or use), are infrequent, low in value, and are customary in a business relationship (e.g., pens, coffee mugs or calendars). If any Staff is uncertain about whether a gift is permitted or not, he or she must seek guidance from their supervisor, or a Compliance Officer.

I thank a participant in a medical writers association’s e-mail discussion list for mentioning the inconsistency.